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Female Reproductive System ORGAN SYSTEMS

Renal cortical necrosis (RCN)

Introduction

Irreversible prerenal acute kidney injury (AKI) characterized by patchy/diffuse ischemic destruction of the renal cortex.

  • RCN accounts for 6-7% of all causes of acute kidney injury (AKI)

Aetiology

Obstetrical cause (50–70% cases):

  • Septic abortion
  • Puerperal sepsis
  • Abruptio placentae
  • Eclampsia
  • Obstetric haemorrhage
  • Intrauterine death (IUD)
  • Thrombotic microangiopathy of pregnancy (P-TMA)

Non-obstetrical causes (20-30% cases. ♂>♀):

  • Extensive burns, sepsis, HUS, pancreatitis, snake bite, and diabetic ketoacidosis
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Causes of renal cortical necrosis of all cases of acute renal failure (n = 1822); 1984-2005. | Prakash J, Vohra R, Wani IA, Murthy AS, Srivastva PK, Tripathi K, Pandey LK, Usha R. Decreasing incidence of renal cortical necrosis in patients with acute renal failure in developing countries: a single-centre experience of 22 years from Eastern India. Nephrol Dial Transplant. 2007;22:1213–1217

Pathophysiology

  • Significantly diminished arterial perfusion of the kidneys due to spasms of the feeding arteries, microvascular injury, or disseminated intravascular coagulation (DIC).
  • Pathological progression of acute tubular necrosis (ATN)

Clinical features

Clinical course:

  1. Death in uraemia during acute phase
  2. Survival without dialysis
  3. Late return to dialysis/transplant
  4. Survival only with chronic maintenance dialysis/transplant
  5. Late resumption of sufficient renal function to become dialysis independent

Complications

Causes of death during acute phase:

  • Severe uraemia
  • Sepsis
  • Pulmonary oedema
  • Gastrointestinal haemorrhage
  • Hyperkalemia
  • Multiorgan failure
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Causes of mortality in patients with RCN ( n = 30). | Prakash, J., Vohra, R., Wani, I. A., Murthy, A. S., Srivastva, P. K., Tripathi, K., … Raja, R. (2007). Decreasing incidence of renal cortical necrosis in patients with acute renal failure in developing countries: a single-centre experience of 22 years from Eastern India. Nephrology Dialysis Transplantation, 22(4), 1213–1217. https://doi.org/10.1093/ndt/gfl761

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